Effect of comprehensive remote ischemic conditioning in anterior ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: Design and rationale of the CORIC-MI randomized trial

Abstract

Remote ischemic conditioning (RIC) applied during or after ST-segment elevation myocardial infarction (STEMI) is currently the most promising adjuvant therapy to reduce reperfusion injury. Recent animal studies showed that RIC may help the myocardium recover if applied daily during the month after STEMI. The Comprehensive Remote Ischemic Conditioning in Myocardial Infarction (CORIC-MI) trial is a single-center randomized controlled study in which 200 patients undergoing primary percutaneous coronary intervention (PPCI) for anterior STEMI will be randomized in a 1:1 ratio into comprehensive RIC (CORIC) or no intervention (control) groups. CORIC consists of per-RIC (5 cycles of 5-minute ischemia and 5-minute reperfusion of the lower limb immediately after randomization and before reperfusion), post-RIC (5 cycles of 5-minute ischemia and 5-minute reperfusion of the lower limb immediately post-PPCI), and delayed RIC (5 cycles of 5-minute ischemia and 5-minute reperfusion of the lower limb once daily on 2-28 days). Primary endpoint is left ventricular ejection fraction assessed by cardiac magnetic resonance imaging at 30 days. Major secondary endpoints include infarct size and left ventricular volume assessed by cardiac magnetic resonance imaging at 30 days, left ventricular ejection fraction assessed by echocardiography, and major adverse cardiovascular events up to 12 months. This report presents the baseline characteristics of 93 patients (CORIC group, n = 49; control group, n = 44) enrolled into the study as of March 31, 2018. The CORIC-MI trial aims to test the hypothesis that CORIC will improve cardiac function and remodeling in patients with anterior STEMI undergoing PPCI.

Keywords: Primary Percutaneous Coronary Intervention; Remote Ischemic Conditioning; Reperfusion Injury; ST-Segment Elevation Myocardial Infarction.

Figure 1

Patient flow chart of the CORIC‐MI study. Abbreviations: CABG, coronary artery bypass grafting; cMRI, cardiac magnetic resonance imaging; CORIC, comprehensive (per‐, post‐, plus delayed) remote ischemic conditioning; LVEDVi, left ventricular end‐diastolic volume index; LVEF, left ventricular ejection fraction; LVESVi, left ventricular end‐systolic volume index; MACE, major adverse cardiovascular events; MI, myocardial infarction; PPCI, primary percutaneous coronary intervention; RIC, remote ischemic conditioning; STEMI, ST‐segment elevation myocardial infarction; TIMI, Thrombosis In Myocardial Infarction